Medical Training in Community Medicine: A Comprehensive, Academic, Service-Based Curriculum

The University of Pennsylvania's Family Practice Residency includes a significant community medicine component in order to accomplish the goals of addressing the health-related needs of the university's neighbors; exposing residents to the knowledge, skills and attitudes necessary to address the health needs of a community; and encouraging health careers with a community focus. It is my belief that these goals further the agenda of the National Institute of Medicine and Healthy People 2000 and 2010. Longitudinal and block community medicine experiences were established to accomplish these goals. This article describes and discusses three measurable outcomes of this curriculum: (1) individual resident projects, (2) resident class projects and (3) significant career foci in community medicine among resident graduates. I believe that our community medicine program exemplifies medical training in a community setting and furthers the national health agenda.     

Adaptation of an In-Person Internship to a Virtual Format for Public Health Undergraduates

The disruption of traditional, in-person learning due to the COVID-19 pandemic necessitated the rapid development and use of revised and novel learning opportunities using a variety of remote instructional methodologies. This viewpoint describes the process used by an undergraduate Public Health program to transition a traditional, in-person, semester-long, 480-hour internship to a virtual-only learning experience guided by the existing student learning outcomes. Working closely with public health professionals at existing internship agencies, alumni from the program, student interns, and program faculty developed a modified virtual internship composed of 6 components. The development of this modified virtual internship model was guided by previous research on the components of successful internships and the elements of high-impact learning practices.     

Approaches to experiential learning, course delivery and validation in medicine. A background document

Educational models and approaches change over time in their dominance and use, offering a wide selection to educational planners and teachers. This paper discusses aspects of experiential learning, distance learning, learning contracts, portfolios, reflection, appraisal, assessment and validation of education. It offers triggers to further thought and enables the analysis of current educational practice.     

Will They Actually Use It? Teaching Effectively to Ensure Action on Patient Education

Use of appropriate materials, principles of adult learning, and teach-back are key when teaching and confirming understanding in any educational setting. For education to be truly effective though, steps must also be taken to assure the learner will take action on what is taught. Provided are practical tips for teaching effectively, ensuring patient education is both understood and used.     

Assessment of Readability and Learning of Easy-to-Read Educational Health Materials Designed and Written with the Help of Citizens by Means of Two Non-Alternative Methods

Objectives: We compared two non-alternative methods to assess the readability and learning of easy-to-read educational health materials co-written by physicians, educators and citizens. Methods: Data from seven easy-to-read materials were analyzed. Readability formulae, and ad hoc data on readability and learning were also computed. Results: The respondents had a mean age of 48.5 ± 8.3 (SD) years (range 31–57 years). More than two thirds of them were females. About half of the participants had a ‘secondary’ education or more. According to the readability scores – 54 on average – the booklets resulted to be “easy” for a reader who had received a ‘secondary education’ or more. Of the 747 participants, 70% of them found the booklet’s language to be ‘easy’ or ‘very easy’ and 28% ‘sufficiently easy’ for laypersons to understand. About 98% of the readers found the booklets useful. After reading the booklet 92% (simple knowledge rate) of the readers answered the cognitive items correctly. The after-minus-before net increase in knowledge was 24 ± 16% and ranged from 8 to 40% (cognitive or knowledge delta). Conclusions: The availability of readability scores is complementary and it does not replace the need to assess readability and learning by means of structured and tailored questionnaires.     

Waking up the audience: the use of trigger videos in labor education.

Use of trigger videos can enhance union education programs by encouraging an active learning process, in which class members can identify with the problems posed in the video, and are motivated to seek a collective action-oriented solution to those situations which exist in their own workplaces. Such an approach empowers workers to develop their own answers in a supportive and mutually reinforcing context.     

农村小学校开设健康教育课的效果评价

通过对德州市三所农村小学校进行为期1年的健康教育干预及评价显示:一般干预组与对照组相比,卫生知识及信念正确回答率差异有显著性(P<0.01),而口腔卫生行为差异无显著性(P>0.05);加强干预组与对照组相比,卫生知识、信念正确回答率及口腔卫生行为差异均有显著性(P<0.01).由此可见,健康教育,尤其是结合小学生特点开展的健康教育活动是提高小学生卫生知识、信念及行为的易行有效的措施.     

Assessing the Learning Needs of Maternal and Child Health Professionals to Teach Health Promotion

OBJECTIVE: To assess skills and preferred learning formats in teaching health promotion (HP). METHODS: A self-administered needs assessment of Maternal and Child Health (MCH) educators from multiple disciplines was conducted on a convenience sample taken nationally via e-mail using Dillman's method. Respondents rated ability to use, and desire to improve skills in, different teaching strategies (brainstorming, case method, collaborative learning, mini-presentation, reflective exercise, role play) and health concepts (partnership, communication, HP/illness prevention, time management, education, advocacy). Preferred learning formats were assessed with 5-point Likert scale and were analyzed using ANOVA. RESULTS: Fifty-seven percent of respondents (n = 180) taught in an urban setting, 26% suburban, and 17% rural. Most taught at academic health centers (35%), public health clinics (25%), or hospitals (17%). Seventy-five percent were female; average age was 42 years (SD--9.1 years). Specific disciplines showed no major difference in mean responses compared with others. The greatest barriers to integrating HP into teaching were time (82%) and budget (58%). Although a majority of all respondents felt comfortable in their abilities to use the teaching strategies and concepts, an equal percentage still wanted to improve these skills. One-third of respondents had experience using web-based study: 64% of them indicated web-based study as their preferred method of continuing education. CONCLUSIONS: While a majority of MCH educators felt confident using various teaching strategies to teach the integration of HP into practice, most still wished to improve their personal skills. Use of an inexpensive, time-efficient modality to access and learn to teach HP was appealing to respondents across disciplines.     

Design of a Rural Diabetes Self-Directed Care Program

This article describes a rural self-directed care program for adults with diabetes. The intervention consisted of coordinating with primary care clinics, six 2-hour facilitated educational peer groups, communication with physicians, referral tracking and follow-up, telephone support, and cooking demonstrations. The educators minimized lectures and they allowed content to emerge from participant questions and concerns. The program provided culturally tailored written educational materials. The author identifies theory and process issues for designing a diabetes self-directed care program in rural settings.     

Prevalence of multiple antibiotic-resistant Gram-negative bacteria on bagged,ready-to-eat baby spinach

In this study, multiple antibiotic-resistant (MAR) Gram-negative bacteria (GNB) were isolated from triple-washed, bagged, ready-to-eat (RTE) baby spinach. Biochemical identification of randomly selected bacterial colonies showed the predominance of cytochrome oxidase-positive Pseudomonas species. Among the GNB, a higher prevalence of resistance was observed against cefoxitin (93.1%) followed by ampicillin (79.4%), chloramphenicol (72.6%), ceftizoxime (65.7%), aztreonam (64.9%), cefotaxime (53.6%), imipenem (38.3%), ceftazidime (33.5%), gentamicin (32.6%), tetracycline (22.2%), and ciprofloxacin (19.8%). Multiple antibiotic resistance (MAR) linked to two or more antibiotics was found in 95.3% of isolates, and resistance was transferable in the strains tested. These findings confirm the presence of MAR bacteria on RTE baby spinach and suggest that human consumption of this produce would amplify the MAR gene pool via conjugal transfer of MAR genes to commensal gut microflora and bacterial pathogens.     

沈阳市铁西区300名城市居民健康知识现状调查

目的了解沈阳市铁西区居民健康知识知晓情况,为有针对性地开展城区健康教育工作提供依据。方法采用整群随机抽样方法,对辖区内300名居民进行问卷调查。结果城区居民健康知识平均知晓率为56.56%。结论健康知识知晓的程度有职业的优势,机关事业单位人员(干部)健康知识知晓率较高。建议发展这一部分人群为健康教育工作志愿者,提高城区居民健康知识知晓水平。     

Education for health: case studies of two multidisciplinary MPH/MSc public health programmes in the UK

Amidst the winds of change that are blowing across the UK public health (PH) landscape in relation to the essential abilities and national standards that are required for the 'art and science' of PH, the preparation for a new cadre of 'PH professionals' is already underway. Several postgraduate masters programmes in public health (MPH) have taken on board the challenge of addressing the requisite sets of skills and expertise as a guide to their content and delivery. Although there are recommendations regarding teaching PH to undergraduate medical students, little consensus seems to exist on teaching postgraduate PH to non-medically qualified professionals, health managers and administrators. Employing a case study approach, this article analyses the methods used, philosophies and processes, structure and organization, outcomes to date, and lessons learnt from MPH programmes implemented at two institutions in the UK. The programmes have been initiated recently, and have had the opportunity to take on board the recent national guidelines about training standards. The findings indicate that preparatory work of the programmes, and the challenges and strengths in meeting the recent policy developments in PH training are pertinent points. The MPH programmes highlight key issues in interprofessional education and its purpose, its process and its outcomes in relation to multidisciplinary specialist practice. These programmes provide a variety of models for others wishing to develop or restructure their postgraduate PH teaching programmes. The finalization of the national standards for specialist practice in PH in the UK is encouraged, along with clearer working definitions of the domains of expertise required. Collectively, attention to these measures can ensure that the processes which teaching programmes embrace to refine their content and delivery will equip tomorrow's professionals with PH knowledge and skills.     

Health,education and time preference

Education has been shown to be the most important correlate of health. However, the mechanism through which education influences health has been largely unexplained. Grossman argued that education improves health production efficiency. In contrast, Fuchs argued that the association between health and education is not primarily causal but reflects unobserved causes of both outcomes. Instead of education causing better health, some ‘third’ variables may be related to both education and health. The ‘third’ variable most frequently mentioned is time preference. The aim of this paper is to investigate the role of time preference in the relationship between education and health. The role of risk attitude is also investigated. The paper exploits a unique data set of households that incorporated stated preference questions eliciting individuals' time preferences. The results show that the effect of education reduces but does not disappear when controlling for individuals' time preferences. Copyright © 2010 John Wiley & Sons, Ltd.     

Maternal and Child Health Graduate and Continuing Education Needs: A National Assessment

Objectives: The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. Methods: The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. Results: Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staff's need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. Conclusions: Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.